9. Anal fistula / Anal abscess


There are secretion producing glands whıch are called proctodeal glands between interior and exterior sphincter (closing) muscles. If they inflammated, the secretion can't drain off and tries to open a channel between the muscles towards the skin. Since it cannot break through the skin, it accumulates as pus and becomes a painful abscess. If this pus accumulation is not discharged, it propagates and even starts damaging  the surrounding tissues.


If the pus can be discharged, the inflammation calms down quickly. However, a connecting link between the anal channel and the skin may be remain over as a tiny canal, which is called an anal fistula. This tiny canal is lined with a special lining (epithelium), whereby it cannot heal itself off. Depending upon the direction it takes, there are many different types of fistula, which most common types are the ones between the interior and exterior sphincter  (closing) muscles.


-         Obstruction of the proctodeal glands by stool

-         Infections from other body parts

-         Anal diseases like hemorrhoids or fissures

-         Injuries of the intestinal mucosa and anal skin

-         Inflamed bowel diseases like  Morbus Crohn  or Colitis


Patient feels painfull swelling during abscess formation as well as general symptoms such as fever, weakness and urination problems. In the case of fistula, a small skin opening can be visible around the anus area. The secretion causes wetness and skin irritation . It is uncommon to experience  any severe pain. The fistula can exist in such a way over a long period, sometimes years, and shows no tendency for self-healing. Although rarely, changes into malignity can occur in process of time.



It is necessary to widen the area in order to drain the abscess.  After this operation, effected areas would self-heal in a few weeks.

In the case of fistula, it has to be treatened surgically. Nevertheless it shows a high reccurency. Injuries of sfincter (closing) muscles can cause to the disruption of the sealing function of the closing muscles.

As an alternative to the operation, a thread may be inserted in the fistula. This method is very lengthy processes and may not be as successful.

Anal fistula

In our clinic superficial fistula tracts will be opened completely by the diod laser (laser fistulotomy). In case of deeper fistulas, only the outer part of the fistula will be removed as an open procedure.  A special round bodied drill is then inserted into the inner muscle part to clean it from the inside. Finally the fistula  is sealed by a diod laser. The  remaining internal fistula opening will be closed by a mucosa plastic.  When this technique is used, the fistula neither needs to be split, so the malfunction of the closing muscles (incontinence, often scared complication) does not happen any longer.

Prior to operation, the position of the fistula can be determined radiologicaly by Fistulography, MR Tomography or with the Endoultrasound. These methods might be necessary in the event of suspicion on an unusual fistula tract. 


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 Anal diseases - still a topic with taboo   |   Anatomy of the final intestine   |   What are Hemorrhoids actually?   |   How does the illness of the hemorrhoids developed? 
 How does the hemorrhoidal illness express itself?   |  
How Hemorrhoids are treated?   |  
How is the treatment in the Proktoklinik?   |    Anal fissure   |   Anal thrombosis 
Illness of the Linea Dentata   |   Skin folds (Mariscs)   |   Condyloms


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